Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway; Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
Médecins Sans Frontières International , Geneva , Switzerland.
Front Public Health. 2015 Nov 26;3:261. doi: 10.3389/fpubh.2015.00261. eCollection 2015.
Despite the increasing use of telemedicine around the world, little has been done to incorporate quality assurance (QA) into these operations. The purpose of the present study was to examine the feasibility of QA in store-and-forward teleconsulting using a previously published framework. During a 2-year study period, we examined the feasibility of using QA tools in two mature telemedicine networks [Médecins Sans Frontières (MSF) and New Zealand Teledermatology (NZT)]. The tools included performance reporting to assess trends, automated follow-up of patients to obtain outcomes data, automated surveying of referrers to obtain user feedback, and retrospective assessment of randomly selected cases to assess quality. In addition, the senior case coordinators in each network were responsible for identifying potential adverse events from email reports received from users. During the study period, there were 149 responses to the patient follow-up questions relating to the 1241 MSF cases (i.e., 12% of cases), and there were 271 responses to the follow-up questions relating to the 639 NZT cases (i.e., 42% of cases). The collection of user feedback reports was combined with the collection of patient follow-up data, thus producing the same response rates. The outcomes data suggested that the telemedicine advice proved useful for the referring doctor in the majority of cases and was likely to benefit the patient. The user feedback was overwhelmingly positive, over 90% of referrers in the two networks finding the advice received to be of educational benefit. The feedback also suggested that the teleconsultation had provided cost savings in about 20% of cases, either to the patient/family, or to the hospital/clinic treating the patient. Various problems were detected by regular monitoring, and certain adverse events were identified from email reports by the users. A single aberrant quality reading was detected by using a process control chart. The present study demonstrates that a QA program is feasible in store-and-forward telemedicine, and shows that it was useful in two different networks, because certain problems were detected (and then solved) that would not have been identified until much later. It seems likely that QA could be used much more widely in telemedicine generally to benefit patient care.
尽管全球范围内远程医疗的使用日益增加，但在这些操作中纳入质量保证 (QA) 的工作却很少。本研究的目的是利用先前发表的框架，检验存储转发远程咨询中 QA 的可行性。在为期两年的研究期间，我们检验了在两个成熟的远程医疗网络[无国界医生组织 (MSF) 和新西兰远程皮肤病学 (NZT)]中使用 QA 工具的可行性。这些工具包括绩效报告，以评估趋势；自动跟踪患者以获取结果数据；自动调查转诊医生以获取用户反馈；以及回顾性评估随机选择的病例以评估质量。此外，每个网络的高级病例协调员负责从用户收到的电子邮件报告中识别潜在的不良事件。在研究期间，共有 149 名患者回复了与 1241 例 MSF 病例相关的随访问题（即 12%的病例），有 271 名患者回复了与 639 例 NZT 病例相关的随访问题（即 42%的病例）。用户反馈报告的收集与患者随访数据的收集相结合，从而产生相同的回复率。结果数据表明，在大多数情况下，远程医疗建议对转诊医生有用，并且可能对患者有益。用户反馈非常积极，两个网络中的超过 90%的转诊医生认为收到的建议具有教育意义。反馈还表明，在大约 20%的情况下，远程咨询为患者/家庭或为治疗患者的医院/诊所节省了成本。通过定期监测发现了各种问题，并通过用户的电子邮件报告发现了某些不良事件。通过使用过程控制图发现了一个异常的质量读数。本研究表明，存储转发远程医疗中的 QA 方案是可行的，并表明它在两个不同的网络中是有用的，因为发现了某些问题（然后解决了），否则这些问题直到很久以后才会被发现。似乎可以在更广泛的范围内将 QA 用于远程医疗，以造福患者护理。
